Successful management of a monochorionic monoamniotic twin pregnancy with extensive cord entanglement

Abstract

Monochorionic monoamniotic (MCMA) twin pregnancy is rare and is associated with fetal loss, congenital anomalies, prematurity and umbilical cord entanglement. We report the management and outcome of a 29-year-old primigravida in whom a single placenta, two fetuses and no intertwin membrane were identified at 9 weeks of gestation. Surveillance included ultrasound assessment every 2 weeks from 16 weeks, umbilical artery and middle cerebral artery Doppler studies, fetal echocardiography at 20-22 weeks, and inpatient fetal surveillance from 30 weeks. A planned caesarean birth was performed at 32+1 weeks, consistent with guidance recommending planned preterm birth for uncomplicated MCMA twins. Two female neonates weighing 1.5 kg and 1.4 kg were delivered. Both received neonatal intensive care for 15 days and were discharged in stable condition. Maternal recovery was uncomplicated. Marked entanglement of the two umbilical cords was documented intraoperatively. This case illustrates that extensive cord entanglement may coexist with a favourable outcome when early diagnosis, structured surveillance, planned preterm caesarean birth and neonatal support are available.